Clinicians can bill, at least to an extent, to account for complexity. When a patient walks into a clinic for an annual physical, an acute upper respiratory tract infection, or an endless litany of chronic complaints including uncontrolled hypertension, diabetes, and hypercholesterolemia, and an acute complaint, their documentation and the codes they use can differ between a brief med check and some more demanding undertaking.

Modality ≠ Complexity

In radiology, we don’t have complexity. We have modality. MRIs earn more than CTs, which earn more than ultrasounds, which earn more than radiographs. There is no distinction between a unindicated pre-operative screening CXR on a healthy adult and an ICU plain film. There is no distinction between a negative trauma pan-scan in an 18-year-old and a grossly abnormal pan-scan in a 98-year-old with ankylosing spondylitis, multiple fractures, and a few incidental cancers.

Leave aside adjusting actual reimbursement RVUs from payors and the government, which is beyond the scope of this essay and would require changes that are likely ultimately unhelpful in the sense that assigning RVUs for reimbursement is a zero-sum game: paying more for one thing will mean paying less for others. Yes, the reality is that some groups and some locations do have more complex cases than others, but capturing that in a fair way by a third party would be a substantial challenge and one with clear winners and losers. Reimbursement has never been fair: between the wide range of complexity and payor contracts, some doctors (or at least institutions) are simply paid more on a per-effort basis.

Internally, however, a group has limitless wiggle room to adjust internal accounting to reward effort and pursue fairness. Again, on the whole, in an ideal world, everyone receives a combination of easy and hard cases, and therefore everyone’s efforts will, on the whole, be comparable. In practice, this may not be the case in many contexts.

For example, a community division in a large university practice may not be reading the same kinds of cases as their counterparts working in the hospital. Some attendings work in rotations with junior residents, and some don’t. Different shifts and different silos across practices that involve different hospitals or different centers can vary widely, and even imaging centers in strip malls may draw different kinds of pathology by zip code and referral patterns. Even covering the ER may yield different sorts of cases with different issues, depending on the time of day. Deep night, high-speed MVCs at 3 am at your hospital may be different from the parade of elderly falls that come during the late morning. If all radiologists share in the differing kinds of work equally, no biggie, but especially in larger practices, that is not always the case.

Across modalities and divisions, it can be relatively straightforward to account for an internal work unit according to generalized desirability or typical time spent. A group might choose to bump the internal RVUs of radiographs and decrease them for some varieties of MRI. A group might decrease single-phase abdomen/pelvis CTs and increase chest CTs. A group might bump thyroid ultrasounds but decrease right upper quadrant ultrasounds. These sorts of customized “work units” bsaed on average time-to-dictation are common.

But the problem of variable challenge within an exam type is thornier. Complexity varies, and preventing the peek-and-shriek cherry pick is a nontrivial task. A normal MRI of the brain for a 20-year-old with migraines is a different diagnostic challenge than a case of recurrent glioblastoma with radiation necrosis or progression.

Most of the metrics one could use to attempt this feat on a case-by-case basis are gameable and ultimately not tractable. If you use time spent to read the case, it’s very challenging to normalize across individuals with varying intrinsic speed, let alone the fact that someone can open an easy case and leave it open while dropping a deuce. I don’t think anyone wants to live in a world where Big Brother is tracking their mouse movements or other invasive surveillance. Radiologists have a hard enough time fighting the widget factory worker mentality enough as it is.

But even when everyone behaves nicely, having a system that accounts for tough cases would help with frustration, burnout, blah blah. No one likes to get bogged down in a complex case and feel behind. What constitutes a solid day’s work depends on how hard the work is.

Enter the eRVU

Here’s an example of how the scalability of AI could make an intractable problem potentially tractable: the use and application of LLMs on reports after the fact to create a complexity grid to help account for case difficulty. Such a model (or wrapper) could be trained to create a holistic score using a variety of factors like patient age, number of positive or negative findings, and the ultimate diagnosis.

Now, obviously, such solutions–like all things–would be imperfect. It may even be a terrible idea.

For one, you’d have to determine how to weigh and differentiate between essential findings or extraneous details such that dumping word salad into a report does not increase the complexity score when it does not meaningfully add value. We all know that longer is not better. But I think if people are creative, viable experiments could be run to figure out what feels fair within a practice and how to drive desired behavior. It’s possible a big powerscribe dump with report data could yield a pretty robust solution that takes into account what “hard” and “easy” work looks like historically based on report content and the time it took to make it. Or maybe you need to wait for vision-language models that can actually look at pictures.

Again, a non-terrible version of such a product would be for internal workload and efficiency accounting, not for reimbursement. Think of it like the customized wRVU tables already in use but with an added layer that it would work across all exam types instead of just modality.

With an effortRVU, we could account for the relative complexity of certain kinds of cases within any modality. We could account for the relative ease of an unchanged follow-up exam for a single finding, and we could account for the very heavy lift that sometimes drives certain types of cases to be ignored on the list, like temporal bone CTs or postoperative CTs of extensive spinal fusions with hardware complications.

Providing good care for the most challenging cases should never be a punishment for good citizens.

(Yes I’m aware some institutions already use an “eRVU” for educational activities, meetings, tumor boards, etc. Accounting for non-renumerative time is also a defensible approach, but that’s not related to the challenges associated with variable case complexity itself.)

((It’s also worth noting that it’s also not hard to imagine a world where payors try to do things like this without your permission. Long term, how reimbursement changes for work in a post-AI world is anyone’s guess because all the current tools suck.))

Infighting & Fun

Any attempt to differ from the status quo, any variation of customization—whether simple wRVU tweaks or something more dramatic like this—is inevitably fraught. The more such a solution is based on messy human opinions, the more contentious the discussions would likely be. Everyone has an opinion about RVUs, and no one wants to see their efforts undervalued. Every tool is just a reusable manifestation of the opinions that go into it. For example, historically common complaints about the RVUs of interventionalists (often ignoring the critical clinical role our IR colleagues play and the physical presence it requires) are a cultural and financial problem, but probably not an AI one.

It’s worth noting that the desire to not “downgrade” work or deal with infighting is probably why many practices choose to change daily targets and bonus thresholds based on subspeciality, shift-type, etc instead of creating/adjusting work units. It’s the same idea tackled less dramatically from a greater distance.

Counting every activity (phone calls, conferences, etc) is also something that’s been deployed in some settings, but it’s easy to see how taken to extremes such efforts to reward behaviors can veer too far into counterproductive counting games and even tokenizing just being a decent person.

If there is a “right” answer, it may be specific to the company and the people in it, and adding complexity to the system has its own very real costs. Nonetheless, there is a strong argument to be made that some degree of practice effort to make sure that everyone’s work goes noticed and appreciated in a “fair” way is a step in the right direction for subspecialized practices.

Internal productivity metrics help prevent low effort output while smart worklists and other guardrails can ensure largely ethical behavior within the list. (But sure, theoretically, if you can solve case assignment, most everything else that matters should just even out in the long run.)

Ultimately, radiology is a field where, especially in large organizations, it can become easy to feel like an anonymous cog. Individualizing productivity accounting to truly recognize the hard, challenging work many radiologists do—and reward those who are willing to develop expertise and do a good job reading complicated cases—might help humanize the work.

(Or…maybe it would just be more stressful and counter-productive to get less credit for those easy palate-cleansers, I don’t actually know. I do know that this particular food-for-thought is bound to make some people very uncomfortable. You can tell me how far you think the gulf between possible and desirable is.)

Time for my annual update and bump of this post: like every other practice in the country, my group is also hiring!

American Radiology Associates is a 100%-independent physician-owned radiology practice in Dallas-Forth Worth (of which I am a partner/shareholder). We’re privademic: we have part of the practice that works with the Baylor Dallas radiology residency, and we have part of the practice that does not. I enjoy a nice mix.

We’re hiring for body, general, neuro, NM/PET, and breast. All of us in DFW work a hybrid on-site/remote schedule. We are also hiring teleradiologists for body/general imaging.

While our partners are generally in the Dallas/Fort Worth metroplex, we are also offering a 100%-remote partnership-eligible swing position.

The swing shift is 2 pm-10 pm Central Time, weekdays (M-F) alternating every other week + 13 weekends of call (yes that means mostly weekdays and not 7/7, and never any deep nights or super weird circadian-destroying hours). The shifts are a mixture of early outpatient and subsequent general (body + neuro) ED/inpatient work for our regional/community hospitals. Other schedule configurations could be considered on an employee or 1099-basis.

So if you’re in the market, come work with me and check out our great team in Dallas. If you’re interested, send your CV to careers@americanrad.com and CC me at ben.white@americanrad.com.

(more…)

I was at the ACR last weekend (giving a talk about the current radiology practice landscape) and had the chance to enjoy one of the American Board of Radiology’s periodic update sessions, this time given by Executive Director Dr. Wagner (who, for the record, is a nice guy). There were several things that I would have loved to ask (or push back on) but wasn’t able to due to time. I thought I’d share some of that here.

On Representation

Dr. Wagner said that the reason they don’t have specific stakeholder representation slots—like a member from the ACR, trainees (RFS), or young professionals (YPS)—is that they believe those people would advocate for their specific stakeholders instead of patients, who are the true mission of the ABR.

The mission, for those who don’t know:

Our mission is to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.

Leave aside that such stakeholder advocacy/perspective would be perfectly reasonable and not necessarily at odds with the ABR’s mission, but if you happened to read my article on the ABR’s bylaws from back in 2019, you may recall how the election of the board of governors works. From the updated November 2024 bylaws:

Section 4.3. Election of Governors. Nominees shall be solicited from the Board of Trustees and the Board of Governors, and may be solicited from any appropriate professional organization. Professional organizations shall provide such nominations in writing. An affirmative vote of at least three-fourths (3/4ths) of the entire Board of Governors shall be necessary for the election of any nominee to the Board of Governors.

I would say this process is insular and suspect, and I don’t see any plausible argument for how this method ensures a board that is more “mission-driven” than any other method. Company boards are usually elected by shareholders and not the boards themselves because external accountability is critical for governance.

Dr. Wagner admits the average age of the board is, in his words, “very old.” But since the board leadership itself selects the future board leadership without external stakeholder accountability or vote, the control and trajectory rest entirely internally. Dissident voices have no power and no recourse to engender change.

(The ABR would tell you they take oodles of feedback via various stakeholder panels and work groups. I really, really, don’t think that’s sufficient. Of course the leadership is old when the process of getting on the board has often meant paying your dues through years of volunteering and ultimately being selected by the board itself to fill its own vacancies.)

If you’ve read the bylaws of the ABR, you would also know that the fiduciary duty of the board members is to the board itself—not to the field of radiology, not to patients, and not even to its stated mission. From Section 6.1, Conflicts of Interest:

It is the policy of this Corporation that the legal duty of loyalty owed to this Corporation by an individual while serving in the capacity as a member of the Board of Governors or Board of Trustees requires the individual to act in the best interests of this Corporation. Consistent with the duty of loyalty, a person serving as a member of the Board of Governors or Board of Trustees does not serve or act as the “representative” of any other organization, and said member’s “constituency” as a member of the Board of Governors or Board of Trustees of this Corporation is solely this Corporation and is not any other organization or its members.

Arthur Jones of Proctor & Gamble once remarked that “all organizations are perfectly designed to get the results they get.” The reality is that this composition, process, and mandate create an unnecessarily insular crowd of well-meaning people designed to make exactly the kind of system we have. Until this process is deliberately opened to demand outside perspectives, they will simply not occur with enough frequency to make a difference.

On Fees

The ABR was also asked about fees, particularly the fact that the fees for initial certification hurt when you are a trainee (here and here and here are a few posts about fees).

The answer was a bit of self-love about how fees have stayed flat despite inflation (without any consideration to whether they could ever, you know, go down).

I would point out, however, that enrollment in MOC has increased over the years as new diplomates graduate while many of those retiring had been grandfathered—such that revenues from MOC have increased over time.

According to the ABR’s 2023 Form 990, there were approximately 35,200 diplomates enrolled in MOC to the tune of $340 a pop. In 2017, that number was 27,000. The increases won’t continue as grandfathered radiologists eventually all retire, but the revenues from MOC have obviously increased. In 2017, MOC revenues were $9.2 million and total revenues were $17.4 million (a previous deep dive is here if you’re curious). In 2023, it was almost $12 million on total revenues of $18.36 million (this after, to their credit, CAQ exam fees were finally slashed from their ludicrous $3k+ price tag).

This means that MOC accounts for an increasingly large amount of money and a larger fraction of revenues over time. I believe ABMS fees should be decreasing, not increasing—especially for a small group like trainees, who make less, usually do not have assets, and should not be required to pay so much for initial certification, especially as MOC for attending physicians with higher income is now essentially an involuntary permanent revenue stream. Initial certification still costs $3,200—no small sum for a bunch of multiple-choice questions written by volunteers and administered over the internet.

Any inflationary increases in expenses are presumably mostly related to the salaries of their employees. The ABR spent $1.66 million on executive salaries, $7.67 million on other salaries and wages (+$1.1 million on retirement contributions and other benefits), and $1 million on travel.

If the ABR takes its fiduciary responsibilities seriously, I think we can make that math work a little better on behalf of our youngest colleagues.

The Return of Oral Boards

There was frank acknowledgement that the Certifying Exam is duplicative and useless (my words of course, not the way they said it), with a caveat that it was a well-intentioned mistake that seemed like a good idea at the time. I think it was pretty clear from the outset that the current Certifying Exam had no value after the very similar Core Exam.

So, Orals are back (my initial thoughts here). Whatever the downsides, there is no denying that oral boards will provide more value than the current Certifying Exam.

There was lip service paid to the consideration of alternative ideas, like perhaps AI could provide value in the certification process? But this was dismissed with a handwave that “If we can’t all agree on what a good report would look like, how could we have an AI do so?”—which is bizarre in the sense that the same problem arises when assessing communication and critical thinking in the context of an oral examination.

What was not acknowledged is that a knowledge-based MCQ assessment doesn’t test skill (a stated important part of that ABR mission). A small number of contrived oral board cases unquestionably adds a different and useful kind of information, but even this is a skills assessment in only a very limited fashion.

So the critical question remains: are we sufficiently assessing skill with any of our current or proposed exams?

If we are being forward-thinking, we could just acknowledge that multiple-choice knowledge assessments are suboptimal. They have been historically necessary and remain efficient but are increasingly inappropriate in our modern connected world to provide actionable information. Knowledge is simply only part of the game.

Simulation is the only way the ABR can really fulfill its mission, and we are clearly living in a world where we could employ batch grading of dictated or typed answers, forcing residents to make findings from real cases and then provide diagnoses or differentials instead of just picking one from a list.

We could do this without AI, but yes, we certainly could employ AI to help grade answers (if not necessarily full reports). This would be a much more meaningful assessment.

The goal of the ABR exam certification process is to differentiate between competent and incompetent radiologists, and I don’t think we’re there yet. As always, I am disappointed by the lack of imagination at play. We can do better.

I believe in the importance of thriving independent private practices for the field of radiology. True private practice–where doctors control the organization, are responsible to their peers and patients, and earn the full fruits of their labor–is the benchmark that sets the market and provides the anchor against exploitation from unscrupulous employers.

My group, like most groups in this market, is hiring (including a partnership-eligible remote swing position). Here are several more 100%-independent radiologist-owned private practices across the US that are recruiting. If you’re in the market for a new position, consider reaching out with your CV. (Click the triangles for more information.)

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Radiology and Imaging Specialists

(Central Florida: Lakeland/Winter Haven, SW Orlando, Bradenton)

Independent and long-standing group covering a diverse mix of financially sound hospital partners, outpatient imaging centers, an ASC/OBL, clinics, and a multi-specialty group. 50+ radiologists and 10+ midlevel providers. In-house and experienced IT, Credentialing, HR, and Admin team including dedicated Radiology Liaison support 24/7/365.

Recruiting for Body, Breast, Cardiac, Neuro, IR, and General.

Partnership Track:

• 1-year track
• 10 weeks of vacation
• Sign-on bonus
• Internal moonlighting available but not required
• Full benefits including CME allocation

Employee or Contractor:

• Flexible scheduling: Hospital (ED/IP) or outpatient coverage options available
• Fully remote, hybrid, or on-site depending on location(s) and coverage schedule desired
• Competitive compensation

Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com

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Mecklenburg Radiology Associates

(Charlotte, North Carolina)

Established in 1917 and fiercely independent, MRA is a well-respected subspecialized practice of 60 radiologists and growing. They especially take pride in their group culture (seriously, there are some really nice people in that group including one of my old senior residents).

Partnership track:

• 3-year partnership track with 8 weeks of vacation per year
  $400K starting salary and an additional $75K sign-on bonus ($125K with 2+ years of experience)
• On-site daytime hospital and imaging center coverage. Hybrid evening and weekend call coverage, including the option to read from home.
• Available positions: Breast, Body, Cardiovascular, Neuro, Light IR, MSK, Nuclear Medicine, and General

Employee track:

• Fully remote, hybrid, or on-site options
• Competitive salary
• Available positions: General, Overnight ER, Swing Shift ER

Learn more at www.meckrad.com/recruitment.
Contact: Charlene Eichinger at ceichinger@meckrad.com

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Midwest Radiology

(Minneapolis – St. Paul, Minnesota)

Large 175+ subspecialized practice with 17 weeks of vacation. Two-year shareholder track for new graduates and a one-year track with experience.

Positions (On-site):

Positions (Remote):

Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.com

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RAPA

(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)

40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.

• Robust reading room assistants and IT presence to promote peak efficiency
• Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites)
• RadAI automated impressions to improve efficiency.

Partnership track – Central Arkansas (Little Rock, Conway, Searcy, and Pine Bluff) and Northwest Arkansas:

• 1 year to partnership
• 10 weeks vacation + 1/2 day off per week on average for partners
• Highly competitive compensation combined with low cost of living
• Internal moonlighting options to boost income
• Robust CME allowance, signing and moving bonuses, full benefits
• Many work-from-home shift options
• Minimal after-hours requirements – overnight shifts are fully staffed with telerads

100% Remote Nighthawk, partnership track:

• 7 on/14 off, 10 pm-7:45 am CST
• 1 year to partnership
• Competitive compensation, robust CME allowance, signing bonus, full benefits

Employee track:

• General radiology, mammography, and other options available
• Fully remote, hybrid, or on-site options available
• Flexible scheduling
• Competitive salaries
• Robust CME allowance, signing and moving bonuses, full benefits

Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.

Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com

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Eastern Radiologists

(Greenville & Coastal North Carolina)

Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.

Currently seeking candidates with the following training:

• Pediatric Imaging
• Breast Imaging
• Neuroradiology
• Body Imaging
• Nighthawk/Overnight
• General Diagnostic Radiology
• Vascular/Interventional

Details:

• Positions are available in Greenville and other coastal communities in Eastern North Carolina.
• Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
• Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
• Sign-on bonus

Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com

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South Texas Radiology Group

(San Antonio, Texas)

STRG is a well-established, expanding, independent subspecialty practice of 70+ radiologists serving 15 hospitals, multiple freestanding ED facilities, and a large outpatient imaging practice (STRIC). Both onsite and remote positions are available.

STRG is a forward-thinking practice with a strong and cohesive culture. Multiple AI projects are in place and in progress to improve efficiency and quality. Internal moonlighting opportunities are available.

Shareholder Track:

• Flexible associate period as short as 18-months.
• Leads to full partnership with board of directors membership.
• Equity ownership within a large expanding outpatient imaging practice (STRIC)
• Competitive salary with up to $800K starting salary for experienced applicants. Up to $600K starting salary for inexperienced applicants.
• Excellent benefits package
• Onsite and work-from-home options for daily work and call
• Hiring across all specialties, with a current emphasis on Body Imaging and Cardiothoracic/Body

Emergency Radiology Track:

• 1 week on/1 week off (7/7) and 1 week on/2 weeks off (7/14) positions available
• Competitive salary with excellent benefits package available.
• Fully remote and onsite options available.

Employee Mammography Position (Onsite):

• Competitive base salary with excellent benefits package
• No call. No nights or weekends.
• Remote opportunities available for general radiology or body imaging work if interested.

Employee Position – All Subspecialties (Onsite, Hybrid, or Remote ):

• Competitive base salary with excellent benefits package
• 5.5 weekends (day shift) per year. No evening or overnight call.

Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com

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Radiology Associates of Ocala

(Ocala, Florida)

A growing Central Florida private practice, rare for the region, with 70+ radiologists looking for an on-site general radiologist.

• Practice owns multiple imaging centers, generating technical fees and rental income for partners.
• New business ventures of software development and a separate Telerad company.
• Optional internal moonlighting available. Nights are covered by dedicated internal nighthawks.
• Option to rotate/vacation in the US Virgin Islands at a practice-owned timeshare at the St. Thomas Ritz.

Remote Partnership:

• 1-year track, professional-fee exclusive, 226 shifts with 10 weeks vacation and 8 weekends, $500-700k+

On-site Partnership:

• 3-year track, no partnership tiers, additional income from technical fee billing, management revenue, and real estate. Nominal buy-in and equal call/PTO/scheduling for pre-partner and partners. 14+ weeks vacation (~185 shifts/yr), $800k-1mm+

Learn more at https://raocala.com.
Contact: Dr. Vivek Kalra at Vivek.Kalra@raocala.com

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Grand Traverse Radiologists

(Traverse City, Michigan)

Established in 1938, GTR is a 100% physician-owned and operated private practice in a four-season resort town on the bays of Lake Michigan.

• High compensation and 12 weeks vacation
• Post-call weekend days off
• Internal moonlighting available
• Positions/partnerships are on-site, but multiple shifts can be done from home.
• Collegial and youthful group with an average age under 40. All partners are equal.
• Hiring for growth. Lists are caught up!

Needs: Body, Breast, ER/General, and IR

Learn more at https://www.grandtraverseradiologists.com
Contact: Dr. Anthony Livorine at alivorine@gtradiologists.com

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Hudson Valley Radiologists

(Poughkeepsie, New York)

A congenial team of 25 sub-specialized radiologists in New York’s scenic Hudson Valley that understands the importance of work-life balance. Since the 1970s, HVR has been respected in the community and known for its entrepreneurial spirit and excellence in patient care, currently providing services to five local hospitals and multiple outpatient imaging centers.

Learn more at https://www.hvrads.com/
Contact: Dr. Evan Kurz at esk@hvrads.com

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Inland Imaging

(Washington, Oregon, Montana)

Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.

Our practice:

• Sub-specialty interpretations available across all locations.
• All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
• Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
• 2-year Partnership Track.
• Full-Time Radiologist Average Time Off = 15 weeks with the ability to decrease or increase total time off.
• Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
• Salary Range – $450,000 – $600,000
• Full Benefit Package including health, life, vision, dental, disability, and life.
• 401k match, profit sharing contribution, and cash balance plan.
• Hybrid Work Options

Current Openings:

• Remote overnight ER
• Neuroradiology (choice of Spokane, Seattle, Walla Walla, Tri-Cities, or Missoula)
• Washington
  • Tri-Cities (with $75k signing bonus)
    • Breast
    • Neuro
    • MSK
  • Spokane – Pediatrics
  • Moses Lake – General/Breast (with $90k signing bonus, $20k relocation benefit, and annual retention bonus)
  • Colville – General/Breast
• Montana
  • Hamilton – General/Breast
• Oregon
  • Pendleton – General/Breast

More information about these positions can be found on our Independent Radiology listing.

Learn more at https://inlandimaging.com/careers
Contact: Sarah Russell, CEO at srussell@inlandimaging.com

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Iowa Radiology

(Des Moines, Iowa)

34-radiologist subspecialized collegial private practice with long-term stability providing coverage to 30 locations across Central and North Central Iowa. Ownership of several outpatient imaging locations yields distributions from technical fees, and Des Moines is one of the fastest-growing areas in the country with a low cost of living, excellent schools, and low taxes.

Partnership track:

• 2-year partnership track with 12 weeks vacation
• On-site daytime coverage; hybrid night and weekend call coverage
• Greatest needs: Breast, Neuro, General. All subspecialties considered for the right candidate.

Employee track:

• Fully remote, hybrid, or on-site options
• Excellent salary and benefits package, including up to 10 weeks of vacation depending on role/shift
• Immediate Need: 3^rd Shift Radiologist
  • Nine-hour shift, 7 on/14 off, 100% teleradiology
  • 90-120 cases/shift; ~40 of those CT
  • Base compensation $450,000 w/ additional compensation opportunities
    • Additional comp consideration based on subspecialty (for example, can final read neuro cases)
    • Moonlighting available
    • RVU productivity incentives
  • Full benefits package including 401k, health/dental/vision, pension, life insurance, etc. ($83k benefit value annually)
  • Malpractice and tail paid
• Other Available positions: General, Breast, Flex Shift, Overnight
  • Overnight shift is 10p-8a CST, 7 on/14 off, 100% teleradiology with average 90-120 total cases per shift
  • Evening shift is 4p-12a CST, alternating weeks M-F only (26 weeks and no holidays/weekends)

Learn more at http://www.iowaradiology.com
Contact: recruit@iowarad.com

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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last August I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board with 130 groups so far. If you’re in the market, please also check it out for your job-hunting needs.

I don’t think I was ever more uncertain about my chosen field than during the first couple of months of my R1 year. Coming off my intern year, I had gained in skill and responsibility, and I wouldn’t have been unhappy taking on a role as an internist during my PGY2 year.

I didn’t read all that much radiology material during my intern year and had no radiology electives because there was no radiology residency where I did my transitional year (an ACGME requirement). So when I began radiology at a new institution—with new people and a new hospital—it was a complete reset.

The first lecture I attended as a radiology resident was GU #3, the third part in a series of case conferences on genitourinary imaging, covering topics like intravenous pyelograms. I had absolutely no idea what was going on. That feeling—of being completely lost—defined much of my early experience in radiology. I lacked the foundation to get anything meaningful out of the lectures.

In the reading room, I spent a lot of time transcribing and editing reports—often repeating words I didn’t understand about anatomy I barely knew. We had a weekly first-year radiology resident interactive conference (a 2-hour pimp-session) based on chapters from Brant and Helms, but this meant I had to do additional reading on my own time, which didn’t always align with what I needed to learn for my rotation. The questions were always challenging and got harder until you failed. There was no escape.

Of course, in the end, it all worked out. At the time, I benefited from some slower rotations at the VA, which gave me some extra time to shore up my reading. And I kept plugging away, day after day on service, doing my best to understand what I was looking at and awkwardly dictate that into comprehensible English (hopefully quietly enough that no one could hear me).

It’s not weird to find radiology disorienting when you first start—it should be expected. The medical school process trains you for clinical medicine. Especially between third year, fourth year, and the intern year, you develop along a continuum that doesn’t naturally lead toward a career in diagnostic radiology.

Becoming a radiology resident is a step backward in personal efficacy. For someone who has done well in school, met expectations across multiple clerkships, and excelled on tests, it’s frustrating to suddenly feel useless.

Some people struggle with feeling like they’re not a “real doctor” in radiology because they are removed from direct clinical care for a large portion of their time. But that sense of detachment is even more profound when you can’t even do your job yet. You can only watch an attending highlight your entire report, delete it en bloc, and start from scratch so many times before your ego takes a hit.

Some attendings even dictate reports to you word for word as though you’re very slow, inaccurate, fleshy dictation software, and then judge your performance by how well you parrot everything back. This process can feel infantilizing.

But, as I’ve previously discussed in the craftsmanship mentality of residency training, I believe we can find satisfaction in our work by taking pride in doing it well.

Reading books is important. Doing practice cases and questions is important. Watching videos can be helpful. You absolutely must do the extra work to become proficient in radiology. You can’t just rely on the list gods to expose you to the full spectrum of pathology needed to adequately learn radiology and provide high-quality diagnostic care.

When everything feels overwhelming—the sheer volume of material, the anatomical complexity, the endless variations in pathology—the answer is to take it one scan at a time.

From the titular reference of Ann Lamott’s beloved Bird by Bird: Some Instructions on Writing and Life:

Thirty years ago my older brother, who was ten years old at the time, was trying to get a report on birds written that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table, close to tears, surrounded by binder paper and pencils and unopened books on birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, ‘Bird by bird, buddy. Just take it bird by bird.’”

You learn by doing. Every day is a learning experience. Every scan is a chance to learn a new anatomical structure or detail. Every pathology is an opportunity to expand your internal library of normal versus abnormal. Every case is a lesson—not just in recognizing the pathology present but also in differentiating it from other possible diagnoses. Yes, the work has to get done, but it can’t just be about getting through the work.

The key to being good at radiology—beyond hard work, attention to detail, and sustained focus—is realizing that taking it scan by scan isn’t just a temporary survival strategy for residency:

It’s the way we learn—when we’re right, actively reinforcing our knowledge, and when we’re wrong, absorbing the painful but essential lessons that only come from making mistakes over and over and over again.